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Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma

Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in... Mehta et al. Journal for ImmunoTherapy of Cancer 2015, 3(Suppl 2):P234 http://www.immunotherapyofcancer.org/content/3/S2/P234 POSTER PRESENTATION Open Access Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma 1* 2 3 4 4 Kathan Mehta , Leonard Appleman , Hong Wang , Ahmad Tarhini , Rahul Parikh From 30th Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2015) National Harbor, MD, USA. 4-8 November 2015 Background Results The 2014 expert consensus on high dose interleukin-2 From 2003 to 2011, 29,532 patients (weighted number of (HD-IL-2) states that, “Treating a minimum number of patients) with RCC or melanoma who received HD-IL-2 patients per year is important, as quality depends upon were identified, and 124 died during hospitalization, while familiarity and repetition” [1]. The minimum annual receiving HD-IL-2 (0.4%). Higher hospital volume was volume of HD-IL-2 associated with relatively worse out- associated with lower in-patient mortality (Figure 1). The comes is not known. Joinpoint regression identified 3 categories of hospital by annual hospital volume (low: 1-40 per year, medium: Methods 41-120 per year, high >120 per year), which had significant We analyzed the National Inpatient Sample (NIS), one of difference in in-patient mortality (0.83%, 0.29% and 0.13% the largest publicly-available in-patient dataset in United respectively, p=0.0003). On multivariate analysis, the low States (U.S.), which represents a 20% stratified random volume hospitals were associated with higher odds of sample of discharges from all hospitals. The NIS is drawn in-patient mortality (OR 6.1, 95% CI 1.6-23.2, p=0.003) as from all States participating in Healthcare Cost and Utili- compared to high volume hospitals. Additionally, hospitals zation Project, and thus represents 95 percent of the U.S. with annual volume of 1-20 per year had even higher rates population. Patients with melanoma and renal cell carci- of inpatient mortality (1.31% vs. 0.13%, p < 0.0001) and noma (RCC) were identified by using the ICD9 diagnostic multivariate odds (OR 8.9, 95% CI 2.4-33.2, p=0.0006) as codes. From this sample, patients receiving HD-IL-2 were compared to high volume hospitals. identified by ICD9 procedure code 00.15. Annual hospital volume was calculated using a unique hospital number, Conclusion available in the dataset. Using Joinpoint regression analy- Lower annual hospital volume of HD-IL-2 is associated sis, which detects change in trend of in-patient mortality with higher HD-IL2 related in-patient mortality. Annual with change in annual hospital volume, the hospitals were hospital volume of less than 20 treatments is associated classified in 3 volume categories (low, medium and high). with 9 time higher risk of in-patient mortality as compared Multivariate logistic regression was used to identify predic- to high volume hospitals. tors of in-patient mortality controlling for confounders including age, sex, Charlson comorbidity index, RCC, Authors’ details calendar year, urban location and teaching status of 1 2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Department hospital. of Medicine, University of Pittsburgh Medical Center Cancer Pavilion, 3 4 Pittsburgh, PA, USA. University of Pittsburgh, Pittsburgh, PA, USA. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA Full list of author information is available at the end of the article © 2015 Mehta et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mehta et al. Journal for ImmunoTherapy of Cancer 2015, 3(Suppl 2):P234 Page 2 of 2 http://www.immunotherapyofcancer.org/content/3/S2/P234 Figure 1 Published: 4 November 2015 doi:10.1186/2051-1426-3-S2-P234 Cite this article as: Mehta et al.: Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma. Journal for ImmunoTherapy of Cancer 2015 3(Suppl 2):P234. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal for ImmunoTherapy of Cancer Springer Journals

Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma

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Publisher
Springer Journals
Copyright
Copyright © 2015 by Mehta et al.
Subject
Medicine & Public Health; Oncology
eISSN
2051-1426
DOI
10.1186/2051-1426-3-S2-P234
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Abstract

Mehta et al. Journal for ImmunoTherapy of Cancer 2015, 3(Suppl 2):P234 http://www.immunotherapyofcancer.org/content/3/S2/P234 POSTER PRESENTATION Open Access Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma 1* 2 3 4 4 Kathan Mehta , Leonard Appleman , Hong Wang , Ahmad Tarhini , Rahul Parikh From 30th Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2015) National Harbor, MD, USA. 4-8 November 2015 Background Results The 2014 expert consensus on high dose interleukin-2 From 2003 to 2011, 29,532 patients (weighted number of (HD-IL-2) states that, “Treating a minimum number of patients) with RCC or melanoma who received HD-IL-2 patients per year is important, as quality depends upon were identified, and 124 died during hospitalization, while familiarity and repetition” [1]. The minimum annual receiving HD-IL-2 (0.4%). Higher hospital volume was volume of HD-IL-2 associated with relatively worse out- associated with lower in-patient mortality (Figure 1). The comes is not known. Joinpoint regression identified 3 categories of hospital by annual hospital volume (low: 1-40 per year, medium: Methods 41-120 per year, high >120 per year), which had significant We analyzed the National Inpatient Sample (NIS), one of difference in in-patient mortality (0.83%, 0.29% and 0.13% the largest publicly-available in-patient dataset in United respectively, p=0.0003). On multivariate analysis, the low States (U.S.), which represents a 20% stratified random volume hospitals were associated with higher odds of sample of discharges from all hospitals. The NIS is drawn in-patient mortality (OR 6.1, 95% CI 1.6-23.2, p=0.003) as from all States participating in Healthcare Cost and Utili- compared to high volume hospitals. Additionally, hospitals zation Project, and thus represents 95 percent of the U.S. with annual volume of 1-20 per year had even higher rates population. Patients with melanoma and renal cell carci- of inpatient mortality (1.31% vs. 0.13%, p < 0.0001) and noma (RCC) were identified by using the ICD9 diagnostic multivariate odds (OR 8.9, 95% CI 2.4-33.2, p=0.0006) as codes. From this sample, patients receiving HD-IL-2 were compared to high volume hospitals. identified by ICD9 procedure code 00.15. Annual hospital volume was calculated using a unique hospital number, Conclusion available in the dataset. Using Joinpoint regression analy- Lower annual hospital volume of HD-IL-2 is associated sis, which detects change in trend of in-patient mortality with higher HD-IL2 related in-patient mortality. Annual with change in annual hospital volume, the hospitals were hospital volume of less than 20 treatments is associated classified in 3 volume categories (low, medium and high). with 9 time higher risk of in-patient mortality as compared Multivariate logistic regression was used to identify predic- to high volume hospitals. tors of in-patient mortality controlling for confounders including age, sex, Charlson comorbidity index, RCC, Authors’ details calendar year, urban location and teaching status of 1 2 University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Department hospital. of Medicine, University of Pittsburgh Medical Center Cancer Pavilion, 3 4 Pittsburgh, PA, USA. University of Pittsburgh, Pittsburgh, PA, USA. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. University of Pittsburgh Medical Center, Pittsburgh, PA, USA Full list of author information is available at the end of the article © 2015 Mehta et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/ zero/1.0/) applies to the data made available in this article, unless otherwise stated. Mehta et al. Journal for ImmunoTherapy of Cancer 2015, 3(Suppl 2):P234 Page 2 of 2 http://www.immunotherapyofcancer.org/content/3/S2/P234 Figure 1 Published: 4 November 2015 doi:10.1186/2051-1426-3-S2-P234 Cite this article as: Mehta et al.: Impact of annual hospital volume of high dose interleukin-2 infusions on in-patient mortality in patients with melanoma and renal cell carcinoma. Journal for ImmunoTherapy of Cancer 2015 3(Suppl 2):P234. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Journal

Journal for ImmunoTherapy of CancerSpringer Journals

Published: Nov 4, 2015

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